超声联合超声造影在合并桥本甲状腺炎C-TIRADS4类甲状腺结节中的诊断价值

Diagnostic value of ultrasound combined with contrast-enhanced ultrasound in C-TIRADS4 thyroid nodules complicated with Hashimoto’thyroiditis

目的应用单因素及多因素分析结合风险预测模型探讨超声(US)联合超声造影(CEUS)对合并桥本甲状腺炎(HT)C-TIRADS4类甲状腺结节的诊断价值。方法取2021年6月至2023年12月于贵州医科大学附属医院行US及CEUS,并经手术病理结果证实的桥本甲状腺炎合并甲状腺结节患者,按7∶3比例,训练集256例,验证集111例。构建预测模型列线图,绘制校准曲线评估模型校准度,通过受试者工作特征(ROC)曲线分析评估其鉴别效能,构建临床决策曲线(DCA)评估模型临床应用价值。结果多因素Logistic回归分析结果显示:边缘不规则、边缘模糊、微钙化、肿瘤最大直径≤10 mm、造影后边界不清、向心性增强、晚于周围组织增强、增强后结节活动度差及有增强环等可能是结局的影响因素。绘制具有9个独立预测因子的列线图,ROC曲线显示模型准确度良好。拟合优度检验结果提示模型拟合良好。决策曲线显示进行干预的净获益高于对所有人干预和不干预。结论US征象中边缘不规则、边缘模糊、微钙化、肿瘤最大直径≤10 mm为合并HT甲状腺结节的独立危险因素;CEUS征象中造影后边界不清向心性增强、晚于周围组织增强、增强后结节活动度差及有增强环对合并桥本甲状腺炎甲状腺癌的诊断价值较高。

Objective To investigate the diagnostic value of Ultrasound(US)combined with Contrast-enhancement ultrasound(CEUS)in C-TIRADS4 thyroid nodules complicated with Hashimoto’thyroiditis(HT)by using single factor,multi-factor analysis and risk prediction model.Methods US and CEUS were performed in the Affiliated Hospital of Guizhou Medical University from June 2021 to December 2023.The Chinese thyroid imaging reporting and data system(C-TIRADS)classified four types of nodules,and the surgical and pathological results confirmed that the proportion of HT patients with thyroid nodules was 7∶3.There were 256 training sets and 111 verification sets.The calibration curve was drawn to evaluate the calibration degree of the model.The differential efficacy was evaluated by receiver operating characteristic(ROC)curve analysis.The clinical decision curve(DCA)was constructed to evaluate the clinical application value of the model.Results Multivariate logistic regression analysis showed that irregular edge,blurred edge,microcalcification,maximum tumor diameter≤10mm,unclear boundary after angiography,enhanced centrality,later than surrounding tissue enhancement,poor nodule motion after enhancement and enhanced ring might be the influencing factors of outcome.A nomogram with 9 independent predictors was drawn,and the ROC curve showed good accuracy of the model.The results of goodness of fit test indicated that the model fits well.The decision curve showed that the net benefit of intervention is higher than that of intervention for either all or no intervention.Conclusion The independent risk factors of HT thyroid nodule in US signs were irregular edge,blurred edge,microcalcification and maximum tumor diameter≤10 mm.The centrality of CEUS signs enhanced later than that of the surrounding tissue,and the activity of nodules after enhancement and the presence of enhanced rings were of high diagnostic value for thyroid cancer complicated with HT.